Point of Use Cleaning System for Endoscopes

ABSTRACT

The invention includes devices, arrangements and methods for treating an endoscope after use to prevent adhesion of bioburden on internal walls of a lumen of the endoscope. After treatment, the device is stored in the treated condition until cleaning. The device is configured to selectively deliver cleaning solution to the endoscope. The device can be a circulating embodiment having a pump. A filter can be provided to filter debris during circulation. The device can be a non-circulating embodiment having a hydrophobic filter for release of air. Fittings are provided on the device components to selectively attach the device to endoscopes.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to and incorporates by reference theentirety of the following: U.S. Provisional Patent Application62/296,649, filed Feb. 18, 2016, which is pending.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

Not applicable

FIELD OF THE INVENTION

The present invention relates to cleaning of hospital equipment, andmore particularly to the cleaning of endoscopes for preparation forreuse with patients.

BACKGROUND OF THE INVENTION

An endoscope is a flexible device with a camera and, a light source, anda lens system for transmitting images from the camera to an eyepiece ora display monitor. Physicians use endoscopes to look inside of patients'bodies for medical reasons, such as to investigate symptoms, confirm adiagnosis, or administer a treatment. Unlike most other medical imagingtechniques, endoscopes are inserted directly into the body.

Endoscopes are expensive (e.g. $70,000 per instrument) and are thereforedesigned for re-use. After a scope is used on a patient, it must bepre-cleaned, high-level disinfected and in some cases sterilized beforebeing used on a subsequent patient. This procedure is commonly known asreprocessing. Numerous protocols and procedures have been developed forcleaning and sterilizing endoscopes. A typical conventional procedureincludes the following:

1. Scope is used in a surgical procedure

2. Scope is pre-cleaned at the point of use

3. Scope is collected for reprocessing

4. Scope is transported to a cleaning and sterilization facility(typically located in the hospital where the scope was used)

5. Scope is leak tested

6. Scope is manually cleaned

7. Scope is high-level disinfected or

8. Scope is sterilized

9. Scope is inspected for integrity, function and cleanliness

10. Scope is stored to prevent damage and re-contamination

11. Scope is returned to a surgical site for use in surgery

A delay sometimes takes place between steps 2, 3 and 4. After use, anendoscope often retains fluids and tissues from the patient, which canbe referred to as “bio-burden. Delay allows bio-burden inside of thescope to dry out. Once dried, bio-burden inside the scope can bedifficult to remove in step 6 (manual cleaning). Bio-burden inside thescope can retain bacteria and viruses. Currently, a particularlydangerous bacteria is CRE. CRE is antibiotic resistant and kills about40 percent of patients who become infected with it. CRE and otherinfectious agents have been inadvertently transmitted from one patientto another through contaminated endoscopes. In some cases, patients havedied of infection caused by contaminated scopes.

There is thus a need for improved apparatus and methods cleaningendoscopes.

OBJECTS AND SUMMARY OF THE INVENTION

It is an object of the invention to provide devices and methods fortreating endoscopes immediately or shortly after use to preventadherence of bioburden to internal lumen of endoscopes.

It is another object of the invention to provide devices and methods fortreating endoscopes immediately or shortly after use that is easy andeconomical to use in a hospital setting.

It is yet another object of the invention to provide devices and methodsfor treating endoscopes immediately or shortly after use that minimizesor prevents infection of endoscopes by microorganisms.

The foregoing objectives are achieved by providing devices, arrangementsand methods having the features described herein.

The invention includes a device for treating an endoscope after use toprevent adhesion of bioburden on internal walls of a lumen of theendoscope. The device comprises at least one endoscope input member, atrailing end of the at least one endoscope input member configured toselectively attach to at least one of the input ports of the endoscope.The device includes an endoscope outlet member, a leading end of theendoscope outlet member configured to selectively attach to the distalend of the endoscope insertion tube. A cleaning solution is provided. Apump is situated for use in selective circulation of the cleaningsolution through the endoscope input member, through the lumen of theendoscope, through the endoscope outlet member, and back into the lumenof the endoscope via the endoscope input member.

The device preferably includes a reservoir, the reservoir configured forstoring and retaining the cleaning solution until circulation of thecleaning solution in the device. A leading end of the endoscope inputmember is in fluid communication with the reservoir. A filter can besituated for filtering debris from the enzymatic fluid duringcirculation of the enzymatic fluid in the device. The filter can be inthe reservoir, such that the filter is situated for filtering debrisfrom the enzymatic fluid during circulation of the enzymatic fluid inthe device.

An endoscope containment bag is preferably included, the bag sized andconfigured to receive the endoscope, to thereby protect the endoscopeand prevent spilling of the cleaning solution during treatment of theendoscope. The endoscope containment bag can be selectively sealable.The pump can be an electromechanical pump. The pump can be powered by abattery. The pump can be a hand pump. The cleaning solution ispreferably an enzymatic cleaning solution.

A filter is preferably provided, the filter situated for filteringdebris from the cleaning solution during circulation of the enzymaticfluid in the device. The filter can be contained in the reservoir. Anendoscope containment bag is preferably included in the arrangement, thebag sized and configured to receive the endoscope, to thereby protectthe endoscope and prevent spilling of the cleaning solution duringtreatment of the endoscope.

In another embodiment, the device of the invention is a non-circulatingdevice for treating an endoscope after use to prevent adhesion ofbioburden on internal walls of a lumen of the endoscope. The deviceincludes an endoscope containment bag sized and configured to receivethe endoscope, the containment bag having a reservoir formed therein, acleaning solution in the reservoir, and the reservoir configured forstoring and retaining the cleaning solution until delivery to theendoscope. At least one endoscope input member extends from thereservoir, a trailing end of the at least one endoscope input memberconfigured to selectively attach to at least one of the input ports ofthe endoscope. The arrangement includes a distal end plug having aninput connector on a leading end and a hydrophobic filter on a trailingend. The input connector is configured to selectively attach to thedistal end of the endoscope insertion tube. The hydrophobic filter isconfigured to allow air to escape through the hydrophobic filter whileretaining cleaning solution. The reservoir is configured for use inselective delivery of the cleaning solution through the endoscope inputmember and through the lumen of the endoscope, whereby the distal endplug allows escape of air through the hydrophobic filter during deliverywhile retaining the fluid in the endoscope. The cleaning solution ispreferably an enzymatic cleaning solution. The distal end plug caninclude a hose section between the input connector and the hydrophobicfilter. The hose section can be sufficiently transparent to allowverification of delivery of cleaning solution through the endoscope.

Methods of treating an endoscope to prevent adhesion of bioburden oninternal walls of a lumen of the endoscope are provided. In a method ofthe invention, shortly after use of the endoscope in a medicalprocedure, a cleaning solution is injected in the endoscope. Thecleaning solution is circulated in the endoscope, whereby circulation ofthe cleaning solution within the endoscope comprises a treated conditionin which the enzymatic fluid prevents adhesion of bioburden on theinternal walls of the lumen of the endoscope. The endoscope is stored inthe treated condition until cleaning of the endoscope. The treatedcondition is eventually terminated and the scope is cleaned for reuse,such that the treated condition facilitates the cleaning of theendoscope. Other methods of use are provided.

The foregoing and other objects, features, aspects and advantages of theinvention will become more apparent from the following detaileddescription of the invention when considered in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front-side perspective view of one preferred embodiment ofan apparatus arrangement of the invention, featuring anelectromechanical pump and a reservoir housing a filter.

FIG. 2 is a front-side perspective view of one preferred embodiment ofan apparatus arrangement of the invention, featuring anelectromechanical pump and a reservoir for cleaning fluid.

FIG. 3 is a front-side perspective view of one preferred embodiment ofan apparatus arrangement of the invention, featuring a hand pump and areservoir housing a filter.

FIG. 4 is a front-side perspective view of one preferred embodiment ofan apparatus arrangement of the invention, featuring a hand pump and areservoir for cleaning fluid.

FIG. 5 is a front-side perspective view of one preferred embodiment ofan apparatus arrangement of the invention, featuring a non-circulatingconfiguration.

FIG. 6 is a side view of an air eliminating filter for use in anon-circulating embodiment.

PREFERRED EMBODIMENTS OF THE INVENTION

In the following detailed description of the preferred embodiments,reference is made to the accompanying drawings which form a part hereof,and in which are shown by way of illustration specific embodiments inwhich the invention may be practiced. It is to be understood that otherembodiments may be utilized and structural changes may be made withoutdeparting from the scope of the present invention.

The invention provides systems and methods for point-of-contact cleaningof endoscopes. The invention 1 is designed for use with conventionalendoscopes 100, such as the endoscope 100 shown in FIG. 1 . An endoscope100 typically includes a control body 102, a light guide connector 104for providing a light source, and a light guide tube 106 interconnectingthe control body 102 and the light guide connector 104. An insertiontube 108 extends from the control body 102. A distal end 110 of theinsertion guide is configured for insertion into patients for use inviewing internal tissues of the patient. An endoscope 100 has one ormore input ports leading to internal lumen of the endoscope 100. Asdiscussed above, after use in a patient, walls of the endoscope areprone to adhesion of bioburden, which, if not removed, can lead to thepropagation of infectious agents within the lumen of the scope. Whilethe invention 1 is designed particularly for solving the problem ofinfectious agents in flexible endoscopes 100, it can be adapted for usein rigid endoscopes 100. The invention 1 can also be used with otherhospital instruments that require cleaning of internal lumen.

Embodiments of devices for treating an endoscope 100 immediately afteruse to prevent adhesion of bioburden on internal walls of a lumen of theendoscope 100 will now be described. As shown in FIG. 1 , the apparatusof the invention 1 comprises, generally, a reservoir 30 for containingcleaning solution 200, a pump 50 device for delivering enzymatic fluid200, and tubing or other fluid communication means for interconnectingthe foregoing components and delivering and circulating cleaningsolution in an endoscope 100. A filter 40 can be provided for filteringparticulate matter from the cleaning solution 200 during circulation. Anendoscope containment bag 10 is preferably provided for use inprotecting the endoscope 10, containing leakage of cleaning solution200, and facilitating set up of the arrangement of the apparatus 1.

In the context of the invention 1, the term “immediately after use”means sufficiently soon after use in a patient such that theintroduction of cleaning solution 200 into the lumen of the endoscope100 substantially prevents the adhesion of bioburden on the walls of thelumen of the endoscope 100. Ideally, the apparatus of the invention 1will be attached to the endoscope 100 immediately after use of theendoscope 100 in the patient, such as within five minutes after theendoscope 100 has been removed from the patient. However, it isanticipated that the realities of differences in hospital practices anddemands on the labor of hospital personnel will result in situations inwhich “immediately after use” extends beyond five minutes and perhaps to60 minutes or even more. As time goes on after a procedure and bioburdenstarts to dry out, the risk of bioburden adhering to the walls of theendoscope 100 increases, but further research will be needed todetermine risk levels over time.

In one embodiment, the apparatus includes at least one endoscope inputmember 70. As shown in FIG. 1 , the device can include a plurality ofendoscope input members 73 74 75 76 for use in delivering cleaningsolution to multiple input ports of the endoscope 100. The endoscopeinput members 70 are typically flexible tubes, although other structuresor combinations of structures could be used, provided that the inputmember 70 serves to deliver cleaning solution 200 to the endoscope 100.A trailing end 72 of the at least one endoscope input member 70 isconfigured for selective attachment to at least one of the input portsof the endoscope 100.

Connectors 78 are provided on each of the trailing ends of the variousendoscope input members 73 74 75, 76. The connectors 78 selectivelyattach on to the fluid pathway fitments of the endoscope 100. Theconnectors 78 can be specialty custom machined fittings or elastomericconnectors that are configured to selectively attach to the endoscope's100 fluid pathway fitments. Since endoscopes 200 have various designsand fitments, it may be necessary to provide interchangeable connectors78 that can be placed on the input members 73 74 75, 76 as needed toaccommodate different scope designs.

As indicated in FIG. 1 , the apparatus further includes an endoscopeoutlet member 60. A lead end of the endoscope outlet member is 60configured to selectively attach to the distal end 110 of the endoscopeinsertion tube 108. During circulation of cleaning solution 200 in theapparatus of the invention 1, the outlet member channels cleaningsolution 200 discharged from the endoscope insertion tube 108. The tubeset connector for the distal end of the endoscope 100 (discharge end) isdesigned to be a universal fit elastomeric component that not onlyprovides a secure leak proof connection but also covers and protects themost delicate, expensive part of the scopes.

A cleansing solution 200 is used with the apparatus 1. In oneembodiment, the cleansing solution 200 is included as part of theapparatus 1, for ease of use in the pre-cleaning stage. Alternatively,the cleaning solution 200 can be introduced into the apparatus 1 at thetime of use. The cleaning solution 200 is preferably an enzymaticcleaning solution 200, which preferably includes proteolytic enzymes forbreaking down residual bio-proteins into smaller molecules to preventbio-burden from attaching to the walls of the internal lumen of theendoscope 100. The inventors contemplate using conventional enzymaticfluids that are readily available on the market. It is anticipated thatbetween about 20 to about 40 ccs of cleaning solution 200 will be usedper treatment procedure.

In some embodiments, the apparatus 1 includes a pump 50 for circulatingcleaning solution 200. In the embodiment shown in FIG. 1 , the pump 50circulates the cleaning solution through the apparatus 1 such as whenthe arrangement is connected to an endoscope 100. The pump 50 issituated for use in selective circulation of the cleansing solution 200through the endoscope input member 70, through the lumen of theendoscope 100, through the endoscope outlet member 60, and back into thelumen of the endoscope 100 via the endoscope input member 70. The pump50 can be an electromechanical pump, which can be powered by aconventional AC wall outlet, a battery, or like electrical powersources.

As shown in FIGS. 3-4 , the pump 50 can be a hand pump. The hand pump 50is configured to be squeezed by hand to circulate cleaning solution 200through the endoscope 100. It is contemplated that a hand pump 50 wouldbe used as an economical means of providing the functionality of theinvention 1.

In the embodiment of FIG. 1 , the pump includes a reusable motorassembly. An on-off switch is provided for the motor or flow control.Cycle selections can be provided. A display can be provided to show flowpower level (e.g. flow level 1, 2, 3 etc.), running time, batterystatus, flow history, and the like. A programmable micro control modulecan be used to optimize flow conditions (e.g. constant flow at lowrates; intermittent flow, e.g. on for 10 minutes followed by offselectable to 10 to 120 minutes; Ramp up and down flow rate over time;pulsatile flow to generate high shear to dislodge soften debris). Thereusable motor assembly is sealed for easy cleaning. Options forproviding motive force for circulating liquid 200 through the scopeinclude: reusable peristaltic pump for pulsatile flow; water pick likepulsatile; centrifugal disposable pump head; disposable electric pumpfor prime and limited circulation; hand operated pump; crank; bellows;air pot type, and the like. Power sources include conventional walloutlet, disposable battery, rechargeable battery, and the like. Therechargeable battery can be wirelessly charged or through inductiveconnectivity with a power supply. A backup battery power source can beincluded to ensure that circulation continues while endoscope is beingtransported to the cleaning facility.

The device 50 can be configured with processors so that data can bepulled from the pump 50, such as circulation time, volume of fluidcirculated etc. The data can be recorded in order to demonstrate thatthe endoscope 100 has been properly treated prior to the steps ofwashing and sterilization.

The device preferably includes a reservoir 30. The reservoir isconfigured for storing and retaining the cleansing solution 200 untilcirculation of the cleansing solution 200 in the device. In theembodiment of FIG. 1 , a leading end 71 of the endoscope input member 70is in fluid communication with the reservoir 30, such as by attachmentto the reservoir 30. In the embodiment shown in FIGS. 1-4 , thereservoir can be considered a manifold, since it distributes cleaningsolution 200 through multiple outlet ports 34 35 36 37.

While the reservoir can take various forms, it is anticipated that thebag embodiments shown in FIGS. 1-4 will be economical and effective. Thereservoir 30 is preferably prefilled with cleaning solution 200 and issealed shut. No measuring or mixing is required, such that the device 1is ready to use and can be simply connected to the endoscope 100.

Sealing elements can be provided in the interconnecting tubing andmanifold outlet ports to keep liquid in the reservoir 30 until the timeof use. The sealing elements can be frangible elements that are brokenor activated before the cycle begins in order to open the flow paths.For example, the frangible elements can be of sufficient strength toretain the cleaning solution but weak enough to break once circulationpressure is applied such as by turning on the pump. Alternatively, avalve can be used to open the ports. The valve can be a self-containedpiercing pin which creates a fluid passageway (hole) through a laminatedfoil/poly/heat seal layer film structure which seals all inlet andoutlet ports. The pin can be hollow and connected to bellows likestructure to allow translational movement of the pin through the sealingmembranes in a closed system. The pins could have a lockout or safetythat has to be released before pins can moved to pierce the seal. Thisprevents accidental or premature release of the cleaning solution 200from the reservoir 30.

In one embodiment, the reservoir 30 has a fill opening so that thereservoir 30 can be filled with a cleaning solution 200 and sealed shut.The user can thus elect to fill the reservoir 30 immediately prior tohook up to an endoscope 100. In other embodiments, the reservoir 30 isprefilled with cleaning solution 200 and disposed of after use.

The device preferably includes a filter 40 situated for filtering debrisfrom the enzymatic fluid 200 during circulation of the enzymatic fluid200 in the device. Liquid filter 40 will remove debris in fluid that ispassing through the scope and prevents lose particulate tore-contaminate the scope lumens of the endoscope 100. In the embodimentof FIG. 1 , the filter apparatus 40 is in the reservoir 30, such thatthe filter apparatus 40 is situated for filtering debris from theenzymatic fluid 200 during circulation of the enzymatic fluid 200 in thedevice.

The filter 40 is preferably a fluid filter. The filter 40 can be standalone, housed in the reservoir 30 or integrated into the containment bag10 for receiving the scope. The filter 40 and the fluidreservoir/manifold 30 can be incorporated into the bottom film layer sofilm forms one surface of fluid path.

The filter 40 can include a liquid filter media 44. The liquid filtermedia 44 may be a needle punched nonwoven felt or similar constructionwith a 20 μm or smaller rating. The liquid filter media 44 can be finepore mesh or membrane material. The filter media 44 can be enclosed orcontained in a filter sock 42. In the embodiment shown in FIG. 1 , thefilter sock 42 is inside the filter housing 30 and fits over and fastensto the reservoir inlet tube 38 extending into the reservoir 30.

The reservoir 30, liquid filter housing 42, and scope bag 10 arepreferably made of sheet vinyl similar to blood bag material. The seamsare preferably radiofrequency (RF) sealed. If the reservoir 30 ispre-filled with cleaning solution, the film material used to create thechamber 32 of the reservoir 30 is a high barrier film in order tominimize evaporation through the film.

An air eliminating filter is preferably provided as part of fluidcircuit to vent out all or substantially all air in the scope 100 andthe interconnecting tubing. The air eliminating filter is preferablylocated at the connection to the distal end 110 of the scope 100 or isincorporated into the reservoir/manifold 30.

In some embodiments, a loading valve or other resealable opening may beprovided to the reservoir 30 for use in introducing enzymatic fluid 200into the circulation apparatus.

The device preferably includes an endoscope containment bag 10. Theendoscope containment bag 10 is sized and configured to receive anendoscope 100, to thereby protect the endoscope and prevent spilling ofthe cleansing solution 200 during treatment of the endoscope 100. Theendoscope containment bag 10 is preferably selectively sealable, such asby a zip-lock mechanism 18A 18B, zipper, snaps, buttons, hook-and-loop(VELCRO®) fastener, or like fastening means.

As shown in FIGS. 1-4 , the endoscope containment bag 10 can also beprovided with structures for assisting in setting up the arrangement ofthe apparatus 1. For example, in FIGS. 1-4 , an outlet connector 22 andan inlet connector 24 are provided on the bag 10. The outlet connector22 serves to interconnect the endoscope outlet member 60 with a bagoutlet tube 62 in fluid communication. The inlet connector 24 serves tointerconnect a bag input member 64 with a reservoir input tube 66 influid communication. As can be appreciated from FIGS. 1-4 with the bagoutlet and inlet tubes 62 64 operably connected to the pump 50, thearrangement assists in the circulation of cleaning solution 200 throughthe endoscope. In the embodiment of FIGS. 1-4 , the outlet and inletconnectors 22 24 are conveniently located on the side seam of the bag 10adjacent the opening of the bag 10, but other locations could be used.

The containment bag 10 can be a heavy gauge clear flexible vinyl that isradiofrequency (RF) or heat sealed. A sealing means 18, such as aninterlocking seal 18A 18B e.g. a ZIPLOCK® type of arrangement), can beprovided along the opening. Other types of high reliability seals thatensure containment of dirty scopes through all post closure activitiesand actions can be used.

A documentation pouch 20 can be provided on the top surface of thecontainment bag 10. The documentation pouch 20 can store various formsof information, such as patient information or endoscope cleaningrecords.

Non-Circulating Embodiments

While it is contemplated that a circulating and preferably continuousflow of cleaning solution 200 will yield ideal results, costconsiderations may lead to use of simplified systems in some hospitalsettings. To that end, non-circulating embodiments of the invention 1will now be described.

FIG. 5 shows an alternative model that does not have a circulating pump50 and does not circulate liquid 200. This non-circulating embodiment ofthe invention 1 includes an arrangement for filling the lumen of theendoscope 100 with cleaning solution 200 and a hydrophobic filter 96 forallowing air to escape from the endoscope 100 during filling of theendoscope 100. In the embodiment of FIG. 5 , the filling means is areservoir 30. The reservoir 30 is preferably integrally formed with thebag 10, such as on the side of the bag as shown in FIG. 5 . The chamber32 of the reservoir 30 is preferably pre-filled with cleaning solution200. The chamber 32 of the reservoir 30 preferably contains about 25-75cc's of solution 200. This embodiment is simple to operate, eliminatesthe storing of pumps, and provides recurring revenue in the form ofsales of a bag 10 having an integrated and charged reservoir 30. In lieuof an integral reservoir 30 on the bag 10, a separate filling mechanismcould be used, such as a separate bag reservoir 30 that gravity feedsinto the scope through tubing, or a syringe, or like injection means.

FIG. 6 shows an embodiment of a distal end plug 90 assembly for fittingon the distal end 110 of the scope insertion tube 108. The distal endplug 90 is configured to attach to the end of the scope and incorporatesan air venting filter 96 to allow escape of air but not liquid. Thedistal end plug 90 includes a scope input connector 92, a hydrophobicfilter 96 on a distal end, and a hose section 94 fluidly connecting theinput connector 92 and the filter 96. The hose section 94 is preferablyclear, which allows the user to see the liquid coming out and the airescaping; this allows the user to quit pumping cleaning solution 200once the internal channels or lumen of the endoscope 100 are full. Onceno more air comes out, the user knows the lumens are full and can stopthe filling process. The hose section 94 is preferably about 2-4 incheslong. The input connector 92 is preferably made of a semi-soft polymer,such that the connector 92 sealingly accommodates most sizes of scopegeometries. The plug 90 also provides protection for the camera andlight located on the distal tip, so they don't get damaged in transportor handling.

In the embodiment of FIG. 5 , the user connects the tubing 34 35 36, and37 to the inlet ports of the endoscope 200 and the distal end plug 90 tothe insertion tube 108 of the endoscope 100. Once the openings of theendoscope 100 are connected to the device, the user applies pressure tothe reservoir 30 to deliver the cleaning solution 200 to the endoscope100. The hydrophobic filter 96 allows air but not cleaning solution 200to escape during filling. Pressure can be applied by compressing thereservoir 30, such by pushing the hand along the reservoir 30, such thatcleaning solution 200 is pushed out of the reservoir 30 into the tubesand the lumen of the endoscope 100.

Accessories that might be included or sold with the assembly 1 include areusable tray, disposable tubing, absorption pad, moist wipes, and asyringe. The assembly of the invention 1 can be provided in the form ofa kit. The components of the kit are preferably arranged in a convenientformat for assembly prior to use, such as in a surgical tray or case.However, the kit components do not have to be packaged or deliveredtogether, provided that they are assembled or collected together in theoperating room for use at the time of surgery.

The apparatus is preferably reusable, due to the anticipated cost of thepump and motor. However, the enzymatic fluid 200 is not reusable. It maybe desirable to replace the connecting tubing. Consequently, theassociated sale of enzymatic fluid and tubing provides a recurringrevenue stream.

Methods of Use

In operation, the invention presents various methods of use for treatingan endoscope 100 to prevent adhesion of bioburden on internal walls of alumen of said endoscope 100.

The invention is designed to provide an additional step between steps2-3 and 9-10 above, as indicated in new step 3-4 and 9 below:

-   -   1. Scope is used in a surgical procedure    -   2. Scope is pre-cleaned at the point of use    -   3. Scope is treated at the point-of-use by continual circulation        of an enzymatic cleaning solution    -   4. Scope is contained in a sealable containment/pump device    -   5. Scope is collected for reprocessing    -   6. Scope is transported to a cleaning and sterilization facility        (typically located in the hospital where the scope was used)    -   7. Scope is washed    -   8. Scope is sterilized    -   9. Scope is contained in a sealable containment/pump device to        prevent re-contamination    -   10. Scope is returned to the point of care in preparation for        the next procedure    -   11. Repeat steps 1-11 after each use

The invention 1 provides an apparatus that attaches to an endoscope 100at the point-of-use. As soon as an endoscopic procedure is complete, theendoscope 100 is hooked up to the circulation apparatus. The apparatusinfuses and continuously circulates enzymatic cleaning solution 200under low pressure within the critical spaces of the lumen of the scope.Continual circulation of enzymatic fluid inside the lumen keepsbio-burden from drying out. Continual circulation also loosensbio-burden particles.

In one preferred method, shortly after use of an endoscope 100 in amedical procedure, cleaning solution 200 is injected into the endoscope100. The cleaning solution is circulated in in the endoscope 100,whereby circulation of the cleansing solution 200 within the endoscope100 comprises a treated condition in which the enzymatic fluid 200prevents adhesion of bioburden on said internal walls of said lumen ofsaid endoscope.

Hookup of the scope 100 to the liquid supply 30 and collection/suctiontubing connectors is preferably done entirely outside the containmentbag 10 in a dry condition. Once all connections are made, the scope 100and all tubing and set are placed inside the containment bag 10.

Once the setup is completed, the fluid pathways are opened and the pump50 is turned on. Fluid 200 begins recirculating per the selectedconditions until circulation is stopped and disconnected. Once the tubeconnections to the scope 100 are removed the scope 100 can betransferred to the disinfection/cleaning and sterilization operation.The entire tubing set 60 70 and fluid path components can be sealedinside the containment bag and red bagged. It comes close to being aclosed system.

The bag 10 can be sealed shut and placed bottom side down in atote/tray/etc.

The endoscope 100 is stored in the treated condition until cleaning ofthe endoscope 100. The treated condition may involve continuouscirculation of cleaning fluid 200, intermittent circulation of cleaningfluid 200, or a soaking condition after an initial period of fluid 200circulation. During the treated condition, the cleaning solution 200,including preferably enzymes in the cleaning solution 200, preventsbioburden from adhering to walls of internal lumen of the endoscope 100.In some cases, this will involve removal of bioburden from the walls(such as by protein breakdown or detergent action) and in other casesprevention of bioburden from sticking to the walls (such as bymaintaining bioburden in solution). When it is time to clean theendoscope 100 for reuse, the treated condition is terminated. Theendoscope 100 is then cleaned for reuse in the conventional manner,except that the treated condition facilitates the cleaning of theendoscope by reducing or eliminating residual bio-burden on the internallumen of the endoscope 100.

Alternatively, the user can elect not to completely fill the lumens.This option may be particularly suited for the embodiment of FIGS. 5-6 .Air space may speed up fluid motion in the lumens during agitation ofthe apparatus 1, such as by periodic manual agitation or mechanicaloscillating means.

Although the present invention has been described in terms of specificembodiments, it is anticipated that alterations and modificationsthereof will no doubt become apparent to those skilled in the art. It istherefore intended that the following claims be interpreted as coveringall alterations and modifications that fall within the true spirit andscope of the invention.

1-13. (canceled)
 14. A method of treating an endoscope to preventadhesion of bioburden on internal walls of a lumen of said endoscope,comprising: shortly after use of said endoscope in a medical procedure,injecting a cleaning solution in said endoscope, circulating thecleaning solution in the endoscope, whereby circulation of the cleaningsolution within said endoscope comprises a treated condition in whichthe enzymatic fluid prevents adhesion of bioburden on said internalwalls of said lumen of said endoscope.
 15. The method of claim 14,further comprising storing said endoscope in said treated conditionuntil cleaning of said endoscope.
 16. The method of claim 15, furthercomprising terminating said treated condition and cleaning saidendoscope for reuse, whereby the treated condition facilitates thecleaning of said endoscope. 17-20. (canceled)
 21. The method of claim13, wherein shortly after use of said endoscope in a medical procedurecomprises less than five minutes after removal of said endoscope from apatient.
 22. The method of claim 13, wherein shortly after use of saidendoscope in a medical procedure comprises less than sixty minutes afterremoval of said endoscope from a patient.
 23. The method of claim 13,wherein the cleaning solution is an enzymatic cleaning solution.